Healthcare Provider Details

I. General information

NPI: 1366873275
Provider Name (Legal Business Name): CLIFTON SPRINGS HOSPITAL & CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD INTEGRATIVE MEDICINE CENTER
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1350
  • Fax: 315-462-7784
Mailing address:
  • Phone: 315-462-9561
  • Fax: 315-462-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022094
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015013
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number025611
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004665
License Number StateNY

VIII. Authorized Official

Name: DONNA SMITH
Title or Position: CHIEF OPERATING OFFICER
Credential: RN
Phone: 315-462-0100